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General NPI Number Information
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NPI Number | 1164576633
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Entity Type | Individual
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Provider Name | IBIRONKE ODUYEBO M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 01/07/2022
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Provider Practice Location Address
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Address Line | 1396 PICCARD DR
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City | ROCKVILLE
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State | MD
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Zip | 20850-4302
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Country | US
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Telephone | 202-384-4056
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Fax |
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Provider Business Mailing Address
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Address Line | 7106 SWANSONG WAY
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City | BETHESDA
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State | MD
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Zip | 20817-1270
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Country | US
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Telephone | 443-939-5322
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301116305
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 59209
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 4301116305
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License Number State | MI
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